Rowe Christopher W, Murray Kirsten, Woods Andrew, Gupta Sandeep, Smith Roger, Wynne Katie
Departments of Endocrinology and Diabetes; Schools of Medicine and Public Health.
Departments of Endocrinology and Diabetes.
Endocrinol Diabetes Metab Case Rep. 2016;2016. doi: 10.1530/EDM-16-0071. Epub 2016 Dec 2.
Metastatic thyroid cancer is an uncommon condition to be present at the time of pregnancy, but presents a challenging paradigm of care. Clinicians must balance the competing interests of long-term maternal health, best achieved by iatrogenic hyperthyroidism, regular radioiodine therapy and avoidance of dietary iodine, against the priority to care for the developing foetus, with inevitable compromise. Additionally, epidemiological and cellular data support the role of oestrogen as a growth factor for benign and malignant thyrocytes, although communicating the magnitude of this risk to patients and caregivers, as well as the uncertain impact of any pregnancy on long-term prognosis, remains challenging. Evidence to support treatment decisions in this uncommon situation is presented in the context of a case of a pregnant teenager with known metastatic papillary thyroid cancer and recent radioiodine therapy.
Pregnancy is associated with the growth of thyroid nodules due to stimulation from oestrogen receptors on thyrocytes and HCG cross-stimulation of the TSH receptor.Thyroid cancer diagnosed during pregnancy has not been shown to be associated with increased rates of persistent or recurrent disease in most studies.There is little evidence to guide the management of metastatic thyroid cancer in pregnancy, where both maternal and foetal wellbeing must be carefully balanced.
转移性甲状腺癌在妊娠时并不常见，但呈现出具有挑战性的护理模式。临床医生必须在长期孕产妇健康（通过医源性甲状腺功能亢进、定期放射性碘治疗和避免膳食碘来最佳实现）与照顾发育中胎儿的优先事项之间权衡相互竞争的利益，这必然会带来妥协。此外，流行病学和细胞数据支持雌激素作为良性和恶性甲状腺细胞生长因子的作用，尽管向患者和护理人员传达这种风险的程度以及任何妊娠对长期预后的不确定影响仍然具有挑战性。在一名患有已知转移性乳头状甲状腺癌且近期接受放射性碘治疗的怀孕青少年病例背景下，给出了支持在这种罕见情况下治疗决策的证据。
由于甲状腺细胞上雌激素受体的刺激以及人绒毛膜促性腺激素对促甲状腺激素受体的交叉刺激，妊娠与甲状腺结节的生长有关。在大多数研究中，妊娠期间诊断出的甲状腺癌并未显示与持续性或复发性疾病的发生率增加有关。几乎没有证据可指导妊娠期转移性甲状腺癌的管理，在此情况下，必须仔细平衡孕产妇和胎儿的健康。
